Evidence map›Paper›PMID 42126922›Full record

ArticleJournal of behavioral addictions2026

Approach-avoidance tendencies in problematic usage of the internet: Evidence from a multisite study.

Martin Diers, Silke M Müller, Annica Kessling, Anna M Schmid, Tobias A Thomas, Stephanie Antons, Maithilee Joshi, Kseniya Krikova, Miriam Kampa, Lukas Mallon and 17 more

Abstract readMulticenter Study
In one paragraph

Article in Journal of behavioral addictions, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

0numbers the graph read from it
0cells of the map it votes in
0citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

0 citing papers in PubMed.

No citing paper in PubMed yet.

4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

27 authors.

Martin Diers1Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.ORCID https://orcid.org/0000-0002-3257-7299
Silke M Müller2General Psychology: Cognition, Faculty of Computer Science, University of Duisburg-Essen, Duisburg, Germany.ORCID https://orcid.org/0000-0002-6627-2661
Annica Kessling2General Psychology: Cognition, Faculty of Computer Science, University of Duisburg-Essen, Duisburg, Germany.ORCID https://orcid.org/0000-0002-8764-5949
Anna M Schmid5Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.
Tobias A Thomas6Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany.ORCID https://orcid.org/0000-0002-4665-7011
Stephanie Antons3Center for Behavioral Addiction Research (CeBAR), Center for Translational Neuro- and Behavioral Sciences, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.ORCID https://orcid.org/0000-0003-3187-968X
Maithilee Joshi6Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany.
Kseniya Krikova8Clinical Psychology and Psychotherapy, University of Siegen, Siegen, Germany.
Miriam Kampa9Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany.
Lukas Mallon1Department of Psychosomatic Medicine and Psychotherapy, LWL University Hospital, Ruhr University Bochum, Bochum, Germany.ORCID https://orcid.org/0000-0002-6385-6397
Lasse David Schmidt10Department of Psychiatry and Psychotherapy, Research Group S: TEP (Substance use and related disorders: Treatment, Epidemiology, and Prevention), University of Lübeck, Lübeck, Germany.ORCID https://orcid.org/0000-0003-3865-3114
Lena Klein2General Psychology: Cognition, Faculty of Computer Science, University of Duisburg-Essen, Duisburg, Germany.ORCID https://orcid.org/0009-0006-3565-599X
Nanne Dominick11Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany.ORCID https://orcid.org/0009-0004-9218-8756
Kjell Büsche2General Psychology: Cognition, Faculty of Computer Science, University of Duisburg-Essen, Duisburg, Germany.ORCID https://orcid.org/0000-0002-3342-0752
Niklas Meurer2General Psychology: Cognition, Faculty of Computer Science, University of Duisburg-Essen, Duisburg, Germany.ORCID https://orcid.org/0000-0001-7910-5849
Andreas Oelker2General Psychology: Cognition, Faculty of Computer Science, University of Duisburg-Essen, Duisburg, Germany.
Annika Brandtner2General Psychology: Cognition, Faculty of Computer Science, University of Duisburg-Essen, Duisburg, Germany.ORCID https://orcid.org/0000-0002-7646-2338
Christian Montag12Centre for Cognitive and Brain Sciences, Institute of Collaborative Innovation, University of Macau, Macau SAR, China.ORCID https://orcid.org/0000-0001-8112-0837
Klaus Wölfling11Outpatient Clinic for Behavioral Addictions, Department of Psychosomatic Medicine and Psychotherapy University Medical Centre, Johannes Gutenberg University Mainz, Mainz, Germany.
Oliver T Wolf16Cognitive Psychology, Ruhr University Bochum, Bochum, Germany.ORCID https://orcid.org/0000-0002-9320-2124
Hans-Jürgen Rumpf10Department of Psychiatry and Psychotherapy, Research Group S: TEP (Substance use and related disorders: Treatment, Epidemiology, and Prevention), University of Lübeck, Lübeck, Germany.ORCID https://orcid.org/0000-0001-6848-920X
Rudolf Stark9Psychotherapy and Systems Neuroscience, Justus Liebig University Giessen, Giessen, Germany.ORCID https://orcid.org/0000-0003-4299-5280
Astrid Müller6Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hanover, Germany.ORCID https://orcid.org/0000-0001-6176-2947
Elisa Wegmann2General Psychology: Cognition, Faculty of Computer Science, University of Duisburg-Essen, Duisburg, Germany.ORCID https://orcid.org/0000-0002-9373-979X
Tim Klucken8Clinical Psychology and Psychotherapy, University of Siegen, Siegen, Germany.ORCID https://orcid.org/0000-0003-2433-6652
Matthias Brand2General Psychology: Cognition, Faculty of Computer Science, University of Duisburg-Essen, Duisburg, Germany.ORCID https://orcid.org/0000-0002-4831-9542
Sabine Steins-Loeber5Department of Clinical Psychology and Psychotherapy, University of Bamberg, Bamberg, Germany.ORCID https://orcid.org/0000-0002-7651-0627

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Background and aims: Problematic usage of the internet (PUI) refers to maladaptive patterns of specific online activities such as gaming, social networking, online shopping, or pornography use. Building on theoretical frameworks such as the I-PACE model and the incentive-sensitization theory, the present multicenter study (N = 1,015) examined automatic approach and avoidance tendencies toward internet-related cues. Methods: Using an explicit Approach-Avoidance Task (AAT), reaction times to addiction-related and neutral stimuli were assessed and related to symptom severity, cue reactivity, and outcome expectancies. Results: Across all user groups (non-problematic, risky, pathological), participants displayed relative approach tendencies toward internet-related stimuli, with pathological users showing the strongest differentiation between addiction-related and neutral cues. Associations between approach tendencies and both cue reactivity and gratification were best described as linear, with higher cue reactivity and greater experienced gratification being associated with stronger approach tendencies. For symptom severity, curve estimation analyses provided evidence for significant, albeit weak, quadratic associations, suggesting that at high symptom severity approach as well as avoidance tendencies may occur. Discussion and Conclusions: Overall, these findings indicate that approach tendencies toward internet-related cues increase gradually with reward experiences and cue-reactivity, while at higher levels of symptom severity approach or avoidance responses may be observed suggesting that motivational responses remain heterogeneous. From a clinical perspective, approach-avoidance tendencies may serve as behavioral markers relevant to the development and maintenance of PUI and may help inform individualized prevention and intervention strategies targeting cognitive-motivational processes underlying problematic internet use.

Indexed as

Avoidance LearningBehavior, AddictiveInternetInternet Addiction DisorderAdultCuesFemaleHumansMaleMotivationSeverity of Illness IndexYoung Adultapproach biasavoidancebehavioral addictioncognitive biascue reactivityinternet addiction

Identifiers

PMID42126922
PMCPMC13377626

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.